First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

What is the name of the dog you are interested in adopting? (If there is not a specific dog you are interested in, please leave this blank)
Choose an animal: Alley Angie Anna Annie Bud De Boi Cinnamon Cookie Dakota (Dak) Diego Elektra Elly Gidget Ginger Holly Jack Keaton Keno Kiddo Marci Marni Pico Ranger Reggie Romeo Rosey Scud Skylar

Why are you looking to adopt a dog?*

Is this adoption conditional?*
Choose one: Yes No

If yes, explain the condition(s):

Drivers License (State & Number):*

Employer:*

Employer Contact Number:

Please choose housing type:*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence*

Number of Adults in Household:*

Number of Children in Household:*

Ages of Children:

How many hours are you away from home daily?*

How long at current address (years & months)?*

Do you have plans to move within the next 12 months? *
Choose one: Yes No

Are you willing to purchase a crate if needed?
Choose one: Yes No

Do you have a pet door?
Choose one: Yes No

Will you consider obedience class if needed?
Choose one: Yes No

Do all the adults in the household consent to adopting this pet?
Choose one: Yes No

Do you give MARS permission to conduct a home check? *
Choose one: Yes No

Does your landlord have any restrictions on size, weight or breed of pet?*
Choose one: Yes No

Is a pet deposit required? If so, how much?

Contact name and number for landlord:

Name of Veterinarian

Veterinarian's Address

Veterinarian's Contact Number

Do you give MARS permission to contact your veterinarian prior to adoption?
Choose one: Yes No

What animals do your household members have known allergies to?

Whom are you getting this pet for?

Do you plan to chain your pet in the yard?
Choose one: Yes No

Do you prefer your pet to be spayed/neutered? *
Choose one: Yes No

Have you ever adopted an animal before? If so, from whom?

Have you ever given up an animal for adoption? If so, why?

Please describe the pets you currently own.

Which vaccinations are your animals current on

Which heartworm preventative do you currently use?

Agreement I agree to abide by Mobile Animal Rescue Services Inc. guidelines and to return the pet to MARS Inc. if i cannot keep the pet or if the pet is lost or dies. I understand if the information provided on this application is incorrect or untrue, I will relinquish the animal upon demand. I agree to allow a representative of MARS Inc. to inspect my home and yard and if any violations exist, I agree to allow the agent to remove the animal from the premises and this entry shall not constitute trespass. I acknowledge this application is correct and complete to the best of my knowledge. *
Choose one: Yes No